How to Read a Nursing Home Inspection Report
Inspection reports are one of the most detailed, independent records of what actually happens inside a nursing home. With a little context, they are easy to read.
Every nursing home that takes Medicare or Medicaid is inspected by its state survey agency on behalf of the Centers for Medicare & Medicaid Services (CMS). The results feed the health inspection star rating, but the full report tells you far more than the stars do.
How inspections work
- Standard inspections are unannounced and happen at least every 15 months, with a statewide average of about once a year. Inspectors observe care, review records and interview residents, families and staff.
- Complaint inspections can happen at any time after someone files a complaint with the state.
- Fire safety inspections check the building, sprinklers, exits and emergency preparedness separately from health and care.
When inspectors find that a home has not met a federal requirement, they cite a deficiency, sometimes called a citation or “tag”. The home must then submit a plan of correction.
Scope and severity: the letters A to L
Each deficiency gets a letter showing how serious it was and how many residents it affected or could affect:
- A–C: no actual harm, with potential for no more than minimal harm.
- D–F: no actual harm, but potential for more than minimal harm. Most citations fall here.
- G–I: actual harm to a resident.
- J–L: immediate jeopardy, meaning the problem caused, or was likely to cause, serious injury, harm or death.
Within each group, the letters move from isolated (one or a very few residents) to a pattern to widespread. A single isolated D citation is very different from a widespread K.
How to judge what you find
- Look at severity before the count. A home with several low-level citations may be a safer choice than one with a single actual-harm or immediate-jeopardy finding.
- Look for repeats. The same problem cited inspection after inspection, such as falls, infection control or medication errors, suggests a lasting issue rather than a one-off.
- Check the dates. A serious finding from several years ago, followed by clean recent inspections, tells a different story than a recent one.
- Read the narrative. The written description explains what happened. It is often more informative than the code.
- Compare with averages. Each facility profile in this directory shows the home’s deficiency count next to state and national averages.
Where to find the full report
Inspection results are published on Medicare’s Care Compare website, and each nursing home must keep the results of its most recent inspection available for residents and visitors to read. Ask to see it when you visit, and ask staff what has changed since.
Questions to ask a home about its inspections
- What were the main findings in your most recent inspection, and what did you change?
- Have you had any complaint inspections in the past year? What were they about?
- How do you monitor the problem areas that were cited?